Neuro

Question 1

The most common cause of viral encephalitis is…

Answer 1

herpes simplex virus type 1 (HSV-1).

Question 2

what area of the brain does viral encephalitis typically affect and how does this present

Answer 2

temporal and inferior frontal regions of the brain.
presents with Sx such as focal neurological deficits e.g. aphasia
behavioural changes
herpes infection can cause visual changes on MRI in these regions

Question 3

RFs for IIH

Answer 3

obesity

Question 4

presentation of diabetic peripheral neuropathy

Answer 4

glove and stocking distribution of neuropathic pain and/ or loss of sensation.

Question 5

what parameter is used to monitor respiratory effort in neuromuscular conditions such as myasthenia gravis AND why

Answer 5

Forced Vital Capacity (FVC) is the gold standard parameter to monitor in patients with breathing difficulties with a background of neuromuscular conditions as it can pick up early respiratory muscle dysfunction

Question 6

serology blood tests for myasthenia gravis

Answer 6

acetylcholine receptor (anti-AChR) antibody
muscle-specific tyrosine kinase (anti-MusK) antibodies

Question 7

Ix for myasthenia gravis

Answer 7

• serology for AChR + anti-MusK
• serial nerve conduction studies
• CT imaging looking for thymoma which produces the antibodies.

Question 8

when should you consider mechanical ventilation for a pt with myasthenia gravis

Answer 8

If the forced vital capacity is 15 mL/kg or less, the patient should be considered for mechanical ventilation.

Question 9

MX for myasthenia gravis

Answer 9

1st line =
Pyridostigmine: acetylcholinesterase inhibitor.
2nd line =
immunosuppression: steroid or azathioprine

Question 10

when investigating MS why do you measure oligoclonal bands in CSF and serum

Answer 10

to compare the levels between the 2.
if raised in both this suggests systemic inflammation that is being resolved.
if raised only in the CSF this suggests intrathecal production and therefore primary or secondary inflammation in the brain or spinal cord

Question 11

huntingtons Sx

Answer 11

triad:

• Choreoathetosis: Unpredictable, flowing, and writhing movements
• Cognitive impairment: Dementia, often marked by problems with judgment, memory, and other cognitive functions
• Psychiatric abnormalities: Depression, irritability, apathy, and sometimes psychosis

Question 12

inheritance pattern of huntington’s disease

Answer 12

autosomal dominant

Question 13

A right sided inferior homonymous quadrantanopia is produced when…

Answer 13

there is damage to the optic radtion where it passes through the parietal lobe on the contralateral side of the visual field loss

In this case on the left

Question 14

typical presentation of peripheral neuropathy

Answer 14

distal sensory loss and diminished reflexes while motor power is preserved

Question 15

what class of drug is selegiline

Answer 15

MAOI-b

Question 16

1st line Mx for Parkinson’s not causing functional impairment or ↓ QoL

Answer 16

dopamine agonists: ropinarol, rotigotine or pramipexole

Question 17

1st line Mx for Parkinson’s causing functional impairment or ↓ QoL

Answer 17

levodopa + decarboxylase inhibitor

Question 18

key features of normal pressure hydrocephalus

Answer 18

wet, wacky + wobbly

• urinary incontinacne
• dementia
• gait inastability / magnetic gait

Question 19

SAH investigations

Answer 19

• non-contrat CT head - shows spider shaped hyperdensities
• CT angiography to identify aneurisms or vascular malformations that could have caused the bleed
• FBC + clotting screen
• LP if CT is -ve but suspicion remains. shows xanthochromia = bilirubin is CSF due to RBC breakdown

Question 20

SAH Mx

Answer 20

• Neurosurgery for endovascular coiling [surgical clipping=2nd line].
• Nimodipene to prevent vasospasm –> vasospasm-induced cerebral ischaemia

Question 21

cause + Sx of spinal caludication

Answer 21

• spinal stenosis - narrowing of the spinal canal which the spinal crd travels through.
• Leg pain and weakness that worsens with physical activity and is relieved by rest, accompanied by numbness, tingling, and decreased sensation or strength in the lower extremities

Question 22

location + function of brocas area

Answer 22

• inferior frontal gyrus of the dominant hemisphere
• production of speech

Question 23

location + function of Wernicke’s area

Answer 23

superior temporal gyrus of the dominant hemisphere
- understanding of speech

Question 24

lacunar strokes Sx

Answer 24

contralateral Sx:

• pure motor stroke
• pure sensory stroke
• pure sensorimotor stroke
• clumsy hand syndrome
• ataxic hemiparesis

Question 25

MC type of partial seizure

Answer 25

temporal lobe epilepsy

Question 26

temporal epilepsy Sx

Answer 26

• auras: rising abdominal pain, deja vu, auditory or visual hallucinations. Occur 1-2 mins before loss of consciousness.
• automatisms: e.g. lip smacking
• post-octal amnesia.

Question 27

MC cause of vertigo

Answer 27

BPPV» Menieres disease&raquo_space; Labyrinthitis.

Question 28

different causes of vertigo

Answer 28

• BPPV: Short duration of vertigo on head perturbation
• Meniere’s disease: Vertigo lasts hours and is always accompanied by tinnitus: hearing loss, and fullness in the ear
• Labyrinthitis: Preceding viral infection with vertigo and hearing loss lasting days
• Vestibular neuritis: Preceding viral infection with vertigo lasting days, NO hearing loss

Question 29

first-line treatment treatment of focal seizures

Answer 29

Leviteracetam or Lamotrigine

Question 30

Tx for absence seizures

Answer 30

Ethosuximide is used to treat absence seizures

Question 31

RFs for subdural haemorrhage and why

Answer 31

older age and alcohol use, as these both cause brain atrophy, which stretches the veins

Question 32

Gold standard Ix for MS

Answer 32

MRI with contrast as it can show dissemination in time or space for the McDonalds criteria.

Question 33

A bilateral facial nerve palsy with weakness involving all muscles, including the forehead, is commonly caused by

Answer 33

Borrelia burgdorferi infection following a tick bite
Lyme disease

Question 34

sudden onset of dizziness or unsteadyness without focal deficits. query what

Answer 34

posterior circulation stroke

Question 35

what happens at TIA clinic

Answer 35

CT head
carotid doppler
MRI head - to show ongoing infarction = gold standard imaging to Dx stroke
start aspirin
Mx BP

Question 36

define a crescendo TIA

Answer 36

more than 1 TIA in 7 days